Reasons given for discontinuing therapy:
(1) failure to respond at all during the therapeutic trial
(2) serious adverse effects developed
(3) deterioration occurred in one or more areas while on long-term therapy
It is important to careful analyze the situation. What is initially interpreted as being an adverse effect or loss of effectiveness may reflect the appearance of another problem unrelated to the cholinesterase inhibitor therapy.
Therapeutic and side effects may be dose-related. Increasing the dose may improve the therapeutic effect, while a simple dose reduction may make the adverse effect less of a problem.
Dementia affects multiple areas. A cholinesterase inhibitor may have beneficial effects on some areas while being less effective in others. Just because the person shows decline in one area does not mean that the cholinesterase inhibitor should be stopped since it may be controlling symptoms in the other domains.
Addition of memantine or another medication may provide sufficient improvement to continue the cholinesterase inhibitor.
If a decision is made to discontinue the drug, then it should be done slowly and while carefully monitoring the patient. The patient may deteriorate as therapy is withdrawn and it may be necessary to restart the medication quickly.
